IFC-022 Respiratory Viruses, Prevention and Control

IFC-022 Respiratory Viruses, Prevention and Control Appendix A: Summary of Stage Specific Activities October 5, 2014

Outside Respiratory Virus Season

Stage 1

Respiratory Virus Season

Stage 2

RESPIRATORY SEASON DATES & TRIGGERS

INDICATIONS FOR DROPLET PRECAUTIONS

This period occurs after Stage 1 ends in the spring (after 2 consecutive weeks with one or fewer cases of influenza per week AND one or fewer RSV cases per week) and until Stage 1

begins again in the fall (when there are 2 consecutive weeks with at least one influenza case per week OR one RSV case per week).

? Begins when there are 2 consecutive weeks with at least one influenza case per week OR one RSV case per week.

? Return to Stage 1 (end Stage 2) when there are less than 5 influenza cases per week AND less than 5 RSV cases per week.

? End Stage 1 (end respiratory virus season) after 2 consecutive weeks with one or fewer influenza cases per week AND one or fewer RSV cases per week. The positives can occur in any age patient and in an outpatient or inpatient setting at the Johns Hopkins Hospital.

? Begins when there are at least 5 influenza cases per week OR 5 RSV cases per week.

? Ends (return to Stage 1) when there are less than 5 influenza cases per week AND less than 5 RSV cases per week. The positives can occur in any age patient and in an outpatient or inpatient setting at the Johns Hopkins Hospital.

Patients with a clinical suspicion of a respiratory virus infection.

Inpatients meeting any of the following criteria: ? Clinical suspicion of respiratory virus infection ? Influenza-like symptoms (fever 100.4 F or 38 C and other symptoms such as cough, runny nose,

sore throat, body aches) ? Suspected bronchiolitis or pneumonia (increasing oxygen requirement, sputum production) ? Asthma/RAD exacerbation ? COPD exacerbation/flare ? Respiratory failure/decompensation ? Unexplained cardiac disease exacerbation ? Elderly patient with unexplained new onset malaise ? Child with apnea or apparent life-threatening event (ALTE) ? Any pregnant patient with unexplained respiratory symptoms ? Any child < 6 years of age with known HIV infection (excluding neonates with known HIV during

hospitalization after delivery)

PATIENT TESTING

Outside Respiratory Virus Season

Respiratory Virus Season Stage 1

Stage 2

Outpatient Setting - The decision to test a patient for respiratory viruses is left to the clinical discretion of the provider.

Inpatients/Patients Being Hospitalized ? The decision to test for respiratory viruses is left to the clinical discretion of the provider An NP flocked swab* shall be obtained in the following circumstances:

? Admission/transfer to a semi-private room for patients meeting the indications for Droplet Precautions listed above. ? To evaluate for nosocomial infection , new onset unexplained respiratory symptoms and/or unexplained fever with onset 48 hours or more

after admission ? When influenza is circulating in the community, consider testing patients with influenza like symptoms to guide antiviral therapy.

Respiratory virus test panels available: ? Order "Resp Virus Panel ? Standard Pt. LAB (7961)" for all immunocompetent patients. ? Order "Resp Virus Panel ? High risk immunocompromised. Pt. LAB (7962)" for any of the following patients: oncology, organ transplant, HIV, immunomodulatory therapy, ICU, pregnant, neonate or normal host with sudden onset respiratory failure.

*Respiratory virus specimen collection options: ? NP flocked swab (NPS) - PREFERRED: The provider collecting the swab must wear a mask with eye protection, gown and gloves. A fittested N95 or PAPR is not required. ? NP aspirate (NPA) ? Not acceptable for PCR/Immunocompromised Panel: The provider collecting the aspirate must wear a mask with eye protection, gown and gloves. A fit-tested N95 or PAPR is not required. ? NP wash: may be used for patients at risk for significant bleeding; acceptable for all test types.

DURATION OF DROPLET PRECAUTIONS

Outside Respiratory Virus Season

Respiratory Virus Season

Stage 1

Stage 2

Immunocompetent Patients: ? Maintain droplet isolation for a minimum of 5days after symptom onset. If it's unclear when symptoms started, count from day of admission or day droplet isolation was initiated, which ever occurred most recently. ? If 5 days after symptom onset, all respiratory symptoms have resolved or the patient is back to their respiratory baseline, droplet precautions may be discontinued. If respiratory symptoms persist or the patient is not back to their respiratory baseline, maintain droplet precautions until symptoms have resolved/respiratory baseline is achieved. ? Isolation can be discontinued before respiratory symptoms resolve ONLY if the DFA is negative AND there is an alternative explanation of symptoms AND the physician or designee calls HEIC for approval.

Immunocompromised Patients**: ? Maintain droplet isolation for a minimum of 5 days after symptom onset. If it's unclear when symptoms started, count from day of admission or day droplet isolation was initiated, which ever occurred most recently. ? If 5 days after symptom onset, all respiratory symptoms have resolved or the patient is back to their respiratory baseline, a single negative shell vial culture is required to discontinue isolation. Order "Resp Virus Panel ? Standard Pt. LAB." ? If 5 days after symptom onset, respiratory symptoms persist or the patient is not back to their respiratory baseline, maintain droplet precautions. Isolation can be discontinued before respiratory symptoms resolve ONLY if the PCR is negative AND there is an alternative explanation of symptoms AND the physician or designee calls HEIC for approval.( Order "Resp Virus Panel ? High risk immunocompromised Pt LAB (7962)" ) ? Call HEIC to discuss any questions or concerns regarding a patient's isolation status

Rhinovirus ? Isolation is only required if patient is symptomatic. Contact HEIC for approval to discontinue isolation when patient's symptoms resolve. ? If the patient is asymptomatic at the time of initial positive test: no isolation and no additional testing are required.

** Definition of Immunocompromised for the Purposes of Isolation for Respiratory Viruses Solid organ transplant Bone marrow transplant within the past year Cancer chemotherapy (within the last month) High dose steroid therapy defined as greater than 1 month duration at a dose greater than or equal to:

o Adults: dexamethasone 3 mg daily, cortisone 100 mg daily, hydrocortisone 80 mg daily, and/or prednisone 16 mg daily

o Children: dexamethasone 0.15 mg/kg/day, cortisone 5 mg/kg/day, hydrocortisone 4 mg/kg/day, and/or prednisone 0.8 mg/kg/day Receiving anti-rejection drugs such as cyclosporine, imuran, etc. White blood cell count (WBC) < 1000 and / or absolute neutrophil count (ANC) ................
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